Your privacy is very important.

Using Your Insurance for Marriage Counseling

Make an informed decision about using insurance benefits for therapy

My goal here is to make the process of using insurance for therapy transparent so you can make an informed decision. While individuals are covered for work done in therapy, the bottom line is that insurance companies generally do not cover couples or marital counseling because is it not deemed a "medically necessary" event. Never mind that a research constantly shows that living in a distressed relationship makes one more susceptible to real illness that is covered, such as depression or heart disease.

In order for an insurance company to reimburse for services, the therapist must provide paperwork documenting the "procedure" codes (indicating the work that was performed and for how long), and a diagnosis needing treatment. If marriage or couples work is performed, the paper work is still submitted as a treatment for the individual listed as the patient.

Certainly if you are struggling with symptoms that may be the result of a mental illness, by all means getting the help and support you need to get well is very important and is that is exactly what the insurance benefit is designed to cover.

Mental Health Diagnoses

Medical necessity can be shown when someone describes psychiatric symptoms and/or behaviors that interfere with their ability to function at work, school, school or in their relationships. An example might be when someone seeks therapy because they are feeling depressed, or having trouble feeling motivated to take basic care of them self. Maybe they stop visiting friends and family or even have trouble sleeping. Another symptom might be related to huge emotional swings. If someone suffering from these types of symptoms starts therapy, the insurance company requires that the psychotherapist determine a mental health diagnosis and provide that diagnosis to them.

A mental health diagnosis is determined by what is published in the Diagnostic and Statistical Manual of Mental Disorders. The DSM is a handbook for mental health professionals that lists different categories of mental disorders and the criteria for diagnosing them, according to the publishing organization the American Psychiatric Association. What is important to know is that all diagnoses can have actuarial ramifications, just like smoking, age, weight, sex, and previous medical conditions. Once you receive a mental health diagnosis it is important for you to know that all your permanent medical records will include this information. This means that if you are asked the question on an employment application, if you have ever been treated for a mental illness, the answer would need to be “yes”. Does this matter? Consider that A University of Illinois Study revealed that half of the Fortune 500 corporations acknowledged using employee medical records in making employment decisions.

Receiving a mental health diagnosis has implications for future health coverage and employment. Even what is considered the most “gentle” diagnosis which is “adjustment disorder with depressed mood.” I suggest reading this article at MentalHelp.net to understand the implications.

Confidentiality

Many people wish to maintain confidentiality around their attending therapy. In fact, there are many laws specifically set up to protect your confidentiality. Having additional people involved in the process to manage the insurance process degrades your confidentiality on many fronts. The most confidential way is for you to pay me directly for services and seek reimbursement from your insurance company.

Relationships & Marriage Counseling

Using Your Insurance for Marriage Counseling

Make an informed decision about using insurance benefits for therapy

Mental Health Diagnoses

Confidentiality